Department of Medicine, University of Colorado, Aurora, Colorado, USA.
Heart Rhythm. 2010 Jan;7(1):9-14. doi: 10.1016/j.hrthm.2009.09.014. Epub 2009 Sep 11.
Long-term outcomes following ablation of ventricular tachycardia (VT) have not been well described.
The purpose of this study was to identify the incidence and predictors of mortality following catheter ablation of VT in patients with an implantable cardioverter-defibrillator (ICD).
The cohort included in the analysis consisted of patients with ischemic or nonischemic cardiomyopathy undergoing electrophysiologic study and ablation of VT. Catheter ablation of VT involved the use of pacemapping, entrainment mapping (when possible), and substrate modification. Clinical recurrences, ICD therapy history, and mortality were recorded for all patients included in the cohort. Comparisons were made between those subjects who died over a 3-year follow-up period and those who survived.
A total of 208 subjects underwent 327 VT ablations over the course of the study period. Sixty-seven deaths (75% of all deaths and 32% of the cohort) occurred within 3 years after VT ablation. After multivariable adjustment, clinical predictors of mortality included age, lower left ventricular ejection fraction, and presence of renal insufficiency. Procedural variables associated with reduced mortality following VT ablation included presence of hemodynamically tolerated VT, lack of inducibilty of any VT following ablation, and procedural date in the latter part of the study.
The survival rate after VT ablation has improved over time and may reflect improved mapping and ablation techniques, in addition to improved therapies for treatment of congestive heart failure. Tolerated VT and lack of inducible ventricular arrhythmias following VT ablation was associated with improved survival in this study, suggesting their value as a risk factor for subsequent mortality.
心脏性猝死（VT）消融后的长期预后尚未得到很好的描述。
本研究的目的是确定植入式心脏复律除颤器（ICD）患者 VT 消融后死亡率的发生率和预测因素。
本分析纳入的队列包括接受电生理研究和 VT 消融的缺血性或非缺血性心肌病患者。VT 的导管消融涉及使用起搏标测、拖带标测（在可能的情况下）和基质修饰。记录所有纳入队列患者的临床复发、ICD 治疗史和死亡率。比较了在 3 年随访期间死亡的受试者和存活的受试者。
在研究期间，共有 208 例患者接受了 327 次 VT 消融。67 例死亡（所有死亡的 75%和队列的 32%）发生在 VT 消融后 3 年内。经过多变量调整，死亡率的临床预测因素包括年龄、左心室射血分数较低和存在肾功能不全。与 VT 消融后死亡率降低相关的程序变量包括存在血流动力学耐受的 VT、消融后任何 VT 均不可诱导以及研究后期的程序日期。
VT 消融后的生存率随着时间的推移而提高，这可能反映了除颤技术的改善，以及充血性心力衰竭治疗的改善。在这项研究中，VT 消融后耐受 VT 和无可诱导的室性心律失常与生存率的提高相关，这表明它们作为随后死亡率的危险因素具有价值。
